The Role of Psychosocial Screening in Patient Selection for Spine Surgery: A Review

Ethan R. Faye; Jacob R. Ball; Emily S. Mills; Jeffrey Wang; Raymond J. Hah; Ram K. Alluri

doi:10.14444/8429

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Table 1

Summary of measurement tools for psychosocial traits.

Measurement Tool	Number of Items	Internal Consistency (Cronbach’s α)	Test-Retest Reliability (r Value)	Validity
Brief Resilience Scale45,48	6	0.7–0.95	0.69	Construct
Connor-Davidson Resilience Scale-1049	10	0.86	0.87	Construct
Resilience Scale for Adults	37	0.9	0.84	Construct
Pain self-efficacy questionnaire52	10	0.92	0.73	Construct
Short Grit Scale53	8	0.73–0.83	0.68	Criterion
Patient activation measure-1335	22	0.87	0.85	Criterion

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Table 2

Summary of psychosocial screening.

Article	Study Design	Psychosocial Scales Used	Population	Number of Patients	Time From Injury or Follow-Up Period	Preoperative Collection	Level of Evidence ^{^a}	Key Findings
Ahmed et al (2019)57	Cross-sectional survey	BRS, PSEQ	Low back pain, neck pain	195	NA	NA	IV	Independent negative associations of resilience and pain self-efficacy scores with ODI and NDI in patients with low back and neck pain
Coronado et al (2021)58	Retrospective cohort	BRS, PSEQ	Laminectomy	248	6 wk and 12 mo	No	III	Association with resilience and physical function, pain interference, social participation, and disability at both time points; association with pain self-efficacy and disability at 12 mo
Mok et al (2021)63	Retrospective medical record review, abstract	Short Grit Scale, Self-Scoring Self-Control Scale	ACDF, MI-D, MI-TLIF	69	6 mo for ACDF, 2 wk for MI-D, and 6 wk for MI-TLIF	No	III	No significant difference in either grit or self-control and ODI and NDI scores
Wibault et al (2017)69	Randomized controlled trial	Swedish version of the Self-Efficacy Scale	ACDF, PCF	202	6 mo	Yes	I	Self-efficacy improved in patients exposed to physical therapy and those not exposed to physical therapy postoperatively; however, self-efficacy was not studied as a modifier of functional outcomes
Block et al (2019)61	Prospective cohort	PAM-13	Spinal surgery, spinal cord stimulation	581	mean 180 d (SD 79.1)	Yes	II	Patient activation mediated the association between negative risk factors and pain and disability
Skolasky et al (2011)60	Prospective cohort	PAM-13	Lumbar fusion	65	12 and 24 mo	Yes	II	Positive association with patient activation and functional improvement and engagement in physical therapy after surgery
Patel et al (2019)62	Retrospective cohort	PAM-10	ACDF	64	6 wk, 3 mo, 6 mo, and 12 mo	Yes	III	No association between patient activation and any measure of postoperative recovery

↵a Level of evidence based upon the Journal for Bone and Joint Surgery criteria and focused on the psychosocial outcome of interest.70
ACDF, anterior cervical discectomy and fusion; BRS, Brief Resilience Scale; MI-D, minimally invasive lumbar decompression; MI-TLIF, minimally invasive transforaminal lumbar interbody fusion; NA, not available; NDI, Neck Disability Index; ODI, Oswestry Disability Index; PAM, patient activation measure; PCF, posterior cervical fusion; PSEQ, pain self-efficacy questionnaire.